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The Minister would be surprised if I did not mention out-of-hours dentistry, which is in crisis-dentistry is in crisis during the day and at night. If the Minister went to A and E units at night and talked to patients, he would find a huge number who are there simply because they cannot get a dentist during the day. We know that in excess of 1 million patients cannot access NHS dentistry, but when people are in pain and turn up at A and E, we need to ensure that the skill base is available for them.
My hon. Friend the Member for Basingstoke (Mrs. Miller) mentioned walk-in centres integrating with A and E. I have seen that in action and it absolutely works around the country and releases a lot of the pressure from existing A and E units. I am sure all hon. Members visit their A and E units-I am lucky enough to go and visit very many. Many patients could have been seen at a minor injuries unit, but they go to the A and E because they feel safe. Many in A and E wanted to get a GP appointment but could not, and many are sent to A and E after a long call to NHS Direct, when they could have been triaged in a much better way.
Working as an integrated service is crucial if we are to have the out-of-hours and urgent care that we need. The Government disagree with our policies-that is their prerogative-but they should call an election and let the public decide.
The Parliamentary Under-Secretary of State for Health (Ann Keen): I too wish to say how well this debate has gone. There have been improvements in out-of-hours services in the last 12 years. They are good, but they are not great. They have let some people down and we need to improve them further. That is why we have asked Professor Steve Field, the chairman of the Royal College of General Practitioners, and Dr. David Colin-Thomé, the director of primary care services in England, to review the out-of-hours service. The report by the Quality Care Commission will also be presented shortly. We have more work to do on out-of-hours services and we intend to improve them. We need to ensure that PCTs and employers do the checks that are needed.
The hon. Member for North Norfolk (Norman Lamb) said that he wanted to see checks on language and professional competence, and that those should be carried out by the GMC. He claimed that that would require changes to the EU directive. We cannot wait that long. The issues need to be addressed now. PCTs have a legal responsibility to ensure competence in the English language and the practice of medicine. Employers should also have that responsibility, and we need to ensure that that is done. Reform of the EU directive is not necessary to achieve that.
My right hon. Friend the Member for Rother Valley (Mr. Barron) chairs the Health Committee and is well known for his detailed opinions on health. I shall address his points throughout my speech. As my hon. Friend the Member for Dartford (Dr. Stoate) said, with obvious authority, responsibility for out-of-hours services lies with the PCT. The hon. Member for Boston and Skegness (Mark Simmonds) says that he would transfer responsibility for commissioning of out-of-hours services to GPs. They would therefore be liable in law for any failures by locums they employ, or any negligence or failures by an
employed GP. It is no wonder that the BMA is concerned about Conservative policy, which would lay a similar liability on GPs to that which they had before 2004.
My hon. Friend the Member for South Derbyshire (Mr. Todd) spoke movingly about the care of long-term conditions. Such conditions require a different out-of-hours service. In many instances, they require a rapid response team, and many such teams are in place. They are multi-disciplinary, including paramedics and specialist nurses. The hon. Members for Basingstoke (Mrs. Miller) and for Beckenham (Mrs. Lait) also spoke of the need for health care teams with different skills, including physiotherapists, paramedics and nurses.
Martin Salter (Reading, West) (Lab): My hon. Friend mentions nursing. I am interested in the development of policy in that area. Does she intend to follow the Leader of the Opposition and meet the Nurses for Reform campaign group which advocates the wholesale privatisation of the NHS, including out-of-hours care?
The hon. Member for Wyre Forest (Dr. Taylor) spoke of the 111 system, which will be excellent. I am pleased to see that the pilots may be ready as early as May or June. He made a point about the BMA involving GPs in commissioning, but I would go further and look for more nursing staff to be involved in the commissioning of services.
I thank all hon. Members who contributed to this debate and I know that they would want to thank NHS staff. Illness, accidents and ailments pay no attention to the time of day, so we must do all that we can to ensure that patients get the right treatment, at the right time and in the right place, and we must have a system of out-of-hours and urgent care that is achieving that goal. People can now access the NHS in more ways than ever before: through one of the 112 new GP surgeries in the areas with the fewest doctors and the greatest need, and through the new GP-led health centres, of which there is one in every primary care trust, open from 8 am until 8 pm, seven days a week, 365 days a year-there is an excellent one up and running in the heart of Hounslow, and the treatment for my constituents is second to none. People can also access the NHS through local pharmacies, some of which are now open seven days a week and into the night; through minor injuries units and urgent care centres, many of which are nurse-led; and through NHS Direct, either over the phone or online. With so many options to choose from, it is important to give patients and local communities the information to get the help that they need.
The hon. Members for North-East Cambridgeshire (Mr. Moss) and for North Norfolk talked about the patient, Mr. David Gray. Many have expressed their
concern and sympathy about that case, and I would like to align myself with that and with the dignity shown by the hon. Member for North-East Cambridgeshire.
We owe the NHS a great tribute, but we also owe our patients and constituents right and safe care, whether in respect of long-term conditions or urgent dental treatment-many of our dental practices also operate out-of-hours services. Many dentists should be commended for their work rather than constantly criticised for a lack of commitment. They want to contribute to primary care in every way possible by being at the heart of our communities, and many want to, and will, work in the walk-in centres of the future. We are encouraged by the people who work in the NHS and, in particular, by how people want to work in communities. It has been difficult to correct the out-of-hours service, which before 2004 was not effective, but equally the schemes now in place will need the review to be led by Professor Stephen Field. When he reports back, which should be soon, I believe that we will act on it.
We have said that we will address the areas of change in relation to the European rulings, and that we will look at commissioning, because that is key to providing the correct services for all patients. Any GP working for out-of-hours providers is subject to the same checks as all other doctors working in general practice in England. Employers have a duty to ensure that all the doctors whom they employ are suitable for the provision of the services that they are employed to provide, and all doctors, including locums, must be on a PCT's performers list before they can provide primary medical services.
Concerns about individual doctors can be investigated by the GMC, which can, when justified, remove a doctor from the medical register on fitness-to-practise grounds. All our services must be safe and of a high quality. They will be checked by the Care Quality Commission or the other regulators that will be needed. When I look at the extension of patient services since the resources that have been put into the health service, I feel confident that we will continue to improve our practices in every way possible for our constituents, and that is thanks to NHS staff and the commitment that they show.
That this House supports family doctors as the bedrock of healthcare services in the NHS; welcomes the improvements in out-of-hours and urgent care services over the last 12 years; notes that the Carson report in 2000 identified the need for the reform of out-of-hours care which was carried out in 2004; further notes that by the start of 2004 only five per cent. of patients saw their own GP out of hours; acknowledges that GP organisations say that they do not want a return to the system which existed in 1997; understands the continuing need to improve the quality of out-of-hours care; notes that the Government commissioned the first national out-of-hours benchmark to help primary care trusts and providers improve the quality and productivity of out-of-hours services and to reduce local variation; recognises the improvement in healthcare after the introduction of the GP contract in 2004, which has significantly extended weekend and evening opening of surgeries for routine, bookable appointments; recognises that over 77 per cent. of GP practices now offer extended opening hours and that every primary care trust is developing a new GP-led health centre, open from 8 am until 8 pm, seven days a week, 365 days a year; and welcomes plans for people who need urgent care to be able to dial 111 for advice 24 hours a day, seven days a week.
That the draft Motor Vehicles (International Circulation) (Amendment) Order 2010,which was laid before this House on 5 January, be approved. - (Helen Jones .)
That the draft Overhead Lines (Exempt Installations) Order 2010, which was laid before this House on 6 January, be approved. - (Helen Jones .)
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